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3.
JAMA Netw Open ; 4(1): e2034196, 2021 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-33507257

RESUMO

Importance: Graduate medical education (GME) funding consists of more than $10 billion annual subsidies awarded to academic hospitals to offset the cost of resident training. Critics have questioned the utility of these subsidies and accountability of recipient hospitals. Objective: To determine the association of GME funding with hospital performance by examining 3 domains of hospital operations: financial standing, clinical outcomes, and resident academic performance. Design, Setting, and Participants: This study is an economic evaluation of all academic centers that received GME funding in 2017. GME funding data were acquired from the Hospital Compare Database. Statistical analysis was performed from May 2016 to April 2020. Exposures: GME funding. Main Outcomes and Measures: This study assessed the association between GME funding and each aspect of hospital operations. Publicly available hospital financial data were used to calculate a financial performance score from 0 to 100 for each hospital. Clinical outcomes were defined as 30-day mortality, readmission, and complication rates for a set of predefined conditions. Resident academic performance was determined by Board Certification Examination (BCE) pass rates at 0, 2, and 5 years after GME funding was awarded. Confounder-adjusted linear regression models were used to test association between GME funding data and a hospital's financial standing, clinical outcomes, and resident academic performance. Results: The sample consisted of 1298 GME-funded hospitals, with a median (IQR) of 265 (168-415) beds and 32 (10-101) residents per training site. GME funding was negatively correlated with hospitals' financial scores (ß = -7.9; 95% CI, -10.9 to -4.8, P = .001). Each additional $1 million in GME funding was associated with lower 30-day mortality from myocardial infarction (-2.34%; 95% CI, -3.59% to -1.08%, P < .001), heart failure (-2.59%; 95% CI, -3.93% to -1.24%, P < .001), pneumonia (-2.20%; 95% CI, -3.99% to -0.40%, P = .02), chronic obstructive pulmonary disease ( -1.20%; 95% CI, -2.35% to -0.05%, P = .04), and stroke (-3.40%; 95% CI, -5.46% to -1.33%, P = .001). There was no association between GME funding and readmission rates. There was an association between higher GME funding and higher internal medicine BCE pass rates (0.066% [95% CI, 0.033% to 0.099%] per $1 million in GME funding; P < .001). Conclusions and Relevance: This study found a negative linear correlation between GME funding and patient mortality and a positive correlation between GME funding and resident BCE pass rates in adjusted regression models. The findings also suggest that hospitals that receive more GME funding are not more financially stable.


Assuntos
Educação de Pós-Graduação em Medicina/economia , Administração Financeira de Hospitais , Hospitais de Ensino/economia , Internato e Residência/economia , Apoio ao Desenvolvimento de Recursos Humanos/economia , Humanos , Estados Unidos
4.
Acad Med ; 96(3): 425-432, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33031118

RESUMO

PURPOSE: To explore internal medicine residents' and geriatrics fellows' perceptions of how personal, social, and institutional characteristics contribute to their professional identity and subspecialty decisions related to geriatric medicine. METHOD: The authors conducted 23 in-depth, semistructured interviews with internal medicine residents, with and without an interest in geriatrics, and geriatrics fellows across 3 academic medical centers in the United States from October 2018 through June 2019. They then used a qualitative narrative approach to analyze the interview data. RESULTS: Trainees related personal experiences, such as exposure to physicians and experiences with grandparents, to their interest in medicine. Trainees with an interest in geriatrics at 2 institutions did not feel supported, or understood, by peers and mentors in their respective institutions but maintained their interest in the field. The following variations between institutions that are supportive and those that are not were noted: the number of geriatricians, the proximity of the institution to geriatrics clinics, and the ways in which institutional leaders portrayed the prestige of geriatric medicine. Institutional characteristics influenced trainees' understanding of what it meant to be a doctor, what meaning they garnered from work as a physician, and their comfort with different types of complexity, such as those presented when providing care to older adults. CONCLUSIONS: Institutional characteristics may be particularly important in shaping trainee interest in geriatric medicine. Institutions should encourage leadership training and opportunities for geriatricians so they can serve as role models and as hands-on mentors for trainees beginning in medical school. Increasing the number of geriatricians requires institutions to increase the value they place on geriatrics to generate a positive interest in this field among trainees. Institutions facilitating formation of professional identity and sense of purpose in work may consider engaging geriatricians in leadership and mentoring roles as well as curriculum development.


Assuntos
Geriatras/psicologia , Geriatria/educação , Médicos/psicologia , Apoio ao Desenvolvimento de Recursos Humanos/economia , Centros Médicos Acadêmicos/estatística & dados numéricos , Adulto , Idoso , Atitude do Pessoal de Saúde , Escolha da Profissão , Currículo , Feminino , Geriatras/estatística & dados numéricos , Geriatria/estatística & dados numéricos , Humanos , Internato e Residência/estatística & dados numéricos , Entrevistas como Assunto , Masculino , Mentores/psicologia , Percepção/fisiologia , Pesquisa Qualitativa , Apoio ao Desenvolvimento de Recursos Humanos/estatística & dados numéricos , Estados Unidos/epidemiologia
5.
J Am Coll Radiol ; 18(1 Pt A): 103-107, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33031781

RESUMO

Today's female physicians face a "triple whammy" of structural discrimination, rigid work expectations, and increasing educational debt. Coronavirus disease 2019 is disproportionately amplifying these forces on women. The burden of these forces on women, the likely long-term consequences, and some preliminary solutions are discussed.


Assuntos
COVID-19/epidemiologia , Mães , Médicas , Radiologistas/economia , Radiologistas/educação , Adulto , Educação Médica/economia , Feminino , Financiamento Pessoal/estatística & dados numéricos , Humanos , SARS-CoV-2 , Sexismo , Apoio ao Desenvolvimento de Recursos Humanos/economia , Carga de Trabalho
6.
J Grad Med Educ ; 12(5): 583-590, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33149828

RESUMO

Background: Residency training occurs in varied settings. Whether there are differences in the training received by graduates of community- or medical school-based programs has been the subject of debate. Objective: This study examined the perceived preparation for practice, scope of practice, and American Board of Family Medicine (ABFM) board examination pass rates of family physicians in relation to the type of residency program (community, medical school, or partnership) in which they trained. Methods: Predetermined survey responses were abstracted from the 2016 and 2017 National Family Medicine Graduate Survey of ABFM and linked to data about residency programs obtained from the websites of national organizations. Descriptive statistics were used to summarize the data and logistic regression to examine differences between survey results based on type of residency training: community, medical school, or partnership. Results: Differences in the perception of preparation as well as current scope of practice were noted for the 3 residency types. The differences in perception were mainly noted in hospital-based skills, such as intubation and ventilator management, and in women's health and family planning services, with different program types increasing preparedness perception in different domains. Conclusions: In general, graduates of family medicine community-based, non-affiliated, and partnership programs perceived they were prepared for and were providing more of the services queried in the survey than graduates of medical school-based programs.


Assuntos
Medicina de Família e Comunidade/educação , Internato e Residência/classificação , Afiliação Institucional , Adulto , Certificação , Serviços de Saúde Comunitária/economia , Medicina de Família e Comunidade/economia , Feminino , Hospitais Universitários , Humanos , Masculino , Médicos de Família , Inquéritos e Questionários , Apoio ao Desenvolvimento de Recursos Humanos/economia
12.
Br J Nurs ; 29(3): 172-173, 2020 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-32053434

RESUMO

Emeritus Professor Alan Glasper, from the University of Southampton, discusses a government initiative to increase the number of nurses in the NHS through the reintroduction of student funding.


Assuntos
Educação em Enfermagem/economia , Financiamento Governamental , Enfermeiras e Enfermeiros/provisão & distribuição , Estudantes de Enfermagem , Apoio ao Desenvolvimento de Recursos Humanos/economia , Humanos , Medicina Estatal , Reino Unido
13.
J Am Coll Surg ; 230(2): 173-181, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31783093

RESUMO

BACKGROUND: The average medical school debt in 2011 was $170,000, and by 2017 it increased to $190,000. High debt burden has been shown to affect career choices for residents in primary care specialties; however, it has not been well studied among surgical residents. The purpose of this multi-institutional study was to assess the amount of debt among general surgery residents and its effects on their career and lifestyle decisions. STUDY DESIGN: Surveys were distributed to 607 categorical general surgery residents at 19 different residency programs. Degree of debt was assessed and responses compared. RESULTS: Overall, 427 (70.3%) residents completed the survey, 317 (74.2%) of whom reported having student loan debt. Of those with debt, 262 (82.6%) believed that repaying debt was a significant financial burden in residency, 248 (78.3%) thought it would remain a burden after residency, 210 (66.2%) believed their debt would influence their future job choice, and 225 (71%) thought their debt would delay their ability to buy a home. Debt did not affect decisions to get married or have children. There were 109 (25.6%) residents with no debt, 131 (30.8%) with <$200,000, 103 (24.2%) with $200,000 to $300,000, and 83 (19.5%) with >$300,000. Residents with high debt were less likely to feel financially secure now (p < 0.0001) and when thinking about their future (p < 0.0001). They also had higher minimum starting salary goals (p = 0.002) and were less likely to have had assistance paying for their education (p = 0.0001). CONCLUSIONS: Surgical residents believe their debt is a significant financial burden. Furthermore, high debt significantly influences their financial security, practice location, and salary goals.


Assuntos
Escolha da Profissão , Cirurgia Geral/educação , Internato e Residência/economia , Estilo de Vida , Apoio ao Desenvolvimento de Recursos Humanos/economia
15.
Rheum Dis Clin North Am ; 46(1): 119-133, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31757280

RESUMO

Physicians in training and their mentors must be cognizant of ethical concerns related to industry interactions. Mentors perceived to have conflicts of interest or to be engaging in misconduct can unconsciously and profoundly affect the learning and academic environment by implying certain values and expectations. Despite increased awareness of ethical concerns related to industry interactions in clinical practice and research, there remains a need for interventions to prevent ethical transgressions. Ethics education is essential and a move in the right direction, but it alone is likely inadequate in preventing unethical behavior. Education should be supplemented with ethical environments at institutions.


Assuntos
Indústria Farmacêutica/ética , Educação Médica/ética , Ética Clínica , Prática Profissional/ética , Apoio à Pesquisa como Assunto/ética , Reumatologia/ética , Temas Bioéticos/normas , Pesquisa Biomédica/economia , Pesquisa Biomédica/educação , Pesquisa Biomédica/ética , Conflito de Interesses/economia , Currículo/normas , Indústria Farmacêutica/economia , Ética Clínica/educação , Tutoria/ética , Assistência ao Paciente/economia , Assistência ao Paciente/ética , Assistência ao Paciente/normas , Prática Profissional/economia , Prática Profissional/normas , Reumatologia/economia , Reumatologia/educação , Apoio ao Desenvolvimento de Recursos Humanos/economia , Apoio ao Desenvolvimento de Recursos Humanos/ética
16.
J Gerontol B Psychol Sci Soc Sci ; 75(7): 1494-1503, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-31696915

RESUMO

OBJECTIVES: More parents are borrowing to help their children pay for college. These loans may be a source of financial stress and worry, which could influence parents' mental health. We determine whether child-related educational debt is associated with worse mental health among parents and if fathers are more sensitive to this debt than mothers, given potential gender differences in financial decision-making and relationships with adult children. METHOD: Data come from the National Longitudinal Survey of Youth 1979, a nationally representative sample of persons born between 1957 and 1964. We used the Center for Epidemiologic Studies Depression Scale and the Short Form-12 Mental Health Component Score to assess mental health. We restricted our sample to parents who had at least one biological child attend college and who were interviewed at age 50, when mental health was assessed (n = 3,545). RESULTS: Among fathers, having any child-related educational debt versus none was associated with fewer depressive symptoms, but having greater amounts of child-related educational debt was associated with more depressive symptoms and worse mental health. No relationship was found for mothers. DISCUSSION: Our findings indicate that the student debt crisis may also have mental health implications for aging parents, particularly for fathers.


Assuntos
Financiamento Pessoal , Saúde Mental , Pais/psicologia , Apoio ao Desenvolvimento de Recursos Humanos , Adolescente , Depressão/epidemiologia , Depressão/etiologia , Pai/psicologia , Feminino , Financiamento Pessoal/métodos , Financiamento Pessoal/estatística & dados numéricos , Humanos , Modelos Lineares , Estudos Longitudinais , Masculino , Saúde Mental/economia , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Mães/psicologia , Relações Pais-Filho , Fatores Sexuais , Fatores Socioeconômicos , Apoio ao Desenvolvimento de Recursos Humanos/economia , Apoio ao Desenvolvimento de Recursos Humanos/métodos , Apoio ao Desenvolvimento de Recursos Humanos/estatística & dados numéricos , Estados Unidos , Universidades
18.
J Epidemiol ; 30(10): 436-441, 2020 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-31474676

RESUMO

BACKGROUND: Levels of student loan debt have been increasing, but very little research has assessed if this is associated with poor health. The aim was to examine the association between student loans and psychological distress in Japan. METHODS: We conducted a cross-sectional web-based self-administered questionnaire survey in 2017. The sample comprised of 4,149 respondents aged 20-34, with 3,170 graduates and 979 current university students. The independent variables were whether or not current students had student loans, and for graduates, the total amount of their student loan debt. The dependent variable was severe psychological distress assessed using the Kessler Psychological Distress Scale (K6; the cut-off point was 12/13). Covariates were demographic and parents' socioeconomic variables. A Poisson regression analysis with a robust error variance was conducted to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Because there was a significant interaction between current student status and the status of borrowing student loans, stratified analyses were conducted. RESULTS: The percentage of those with student loans was 33.8% among graduates and 35.2% among current university students. Among graduates, student loan debt was significantly associated with a high possibility of having severe psychological distress after adjusting for covariates (PR of ≥4 million yen, 1.44; 95% CI, 1.02-2.03). Among current university students, there was no significant association (PR of borrowing student loans, 0.91; 95% CI, 0.60-1.37). CONCLUSIONS: There was a significant association between student loan debt and psychological distress among graduates but not current university students.


Assuntos
Saúde Mental/estatística & dados numéricos , Angústia Psicológica , Estresse Psicológico/psicologia , Estudantes/psicologia , Apoio ao Desenvolvimento de Recursos Humanos/economia , Adulto , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Apoio ao Desenvolvimento de Recursos Humanos/estatística & dados numéricos , Adulto Jovem
20.
Phys Ther ; 100(4): 591-599, 2020 04 17.
Artigo em Inglês | MEDLINE | ID: mdl-31800062

RESUMO

BACKGROUND: The growing student debt of physical therapists entering the workforce, coupled with the growth in projected need, raises concerns about where and how entry-level physical therapists will practice and if these choices will be affected by their debt burden. OBJECTIVE: The purpose of this study was to identify the debt profile of entry-level physical therapists and explore relationships between student debt and clinical practice setting choices. METHODS: This study utilized a cross-sectional survey design to identify debt profiles and explore relationships between student debt and the clinical practice choices of entry-level physical therapists. RESULTS: The mean debt-to-income ratio based on the total reported educational debt was 197% (93%). The most frequently reported debt range for doctor of physical therapy (DPT) debt and total educational debt was $100,000 to $124,999. Despite the setting itself being rated as the most important factor (83%), 28% of participants reported debt as a barrier to their desired practice setting. In addition, when considering job choice overall, 57% of the participants reported that their student debt has had an effect on their decision. LIMITATIONS: This study is limited by its small sample size, originating from 1 state, and being taken by convenience from a special interest group. Data were collected via an anonymous survey, which increases the risk of selection bias. In addition, there are further personal, family, and institutional characteristics that were not collected in this study, which may influence the interaction between student debt and clinical practice choices. CONCLUSION: The results of this study suggest that practice setting choice may be affected by physical therapist student debt, and student debt may be a barrier overall to practice and career choices in physical therapy.


Assuntos
Renda , Fisioterapeutas/economia , Área de Atuação Profissional/economia , Apoio ao Desenvolvimento de Recursos Humanos/economia , Adulto , Escolha da Profissão , Estudos Transversais , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tamanho da Amostra , Inquéritos e Questionários , Adulto Jovem
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